Download and References - National TB Controllers Association

National Tuberculosis Controllers Association /National Tuberculosis Nursing
Coalition Workgroups
for Public Health Workforce Development in Tuberculosis Programs:
Core Competencies – Corrections Liaison
Overview
In 2004, the National TB Controllers Association (NTCA) President called for a dialogue on educating the
public health workforce to address projected workforce shortages in tuberculosis (TB) programs. Early that
year, an interest group of seven national leaders in TB control was convened to discuss issues of
competencies, workforce shortages, and needs enumeration.
The group agreed that common competencies linked with job responsibilities should be identified to support
competency-based training and development for professionals capable of demonstrating best practices in TB
prevention and control programs. Members active in the role should develop the practice-based duty
statements by brainstorming and discussing, the literature, comparing and reaching agreement, and then
writing the findings, which can be presented to the organization’s leadership for approval and dissemination.
In June, 2004, the NTCA and National TB Nurse Coalition (NTNC) Presidents co-sponsored an adjunct
meeting during the NTCA workshop attended by 50 national TB leaders. With facilitation by the Francis J.
Curry National TB Center, they created four working groups to describe model duty statements and core
competencies for selected roles: nurse consultant; nurse case manager, liaison for corrections, and disease
investigator/outreach worker. Chairs of the four working groups formed a steering committee to coordinate the
work.
Definition of Corrections Liaison:
A person who facilitates coordination and collaboration among staff in local or state public health departments
with staff in correctional or detention facilities and law enforcement agencies with specific regard to public
health actions outside the usual scope of detention health services. The Corrections Liaison should
understand the missions and goals of public health TB programs, correctional facilities, and law enforcement
agencies.
NTCA Corrections Liaison Workgroup
Methods:
This group held their first meeting in June 2004 during the NTCA workshop at which time they determined
many functions of the duty statement as they relate to corrections. Many of the members were responsible for
most role functions, but not all functions were carried out by every member. During 2005 and 2006, the work
continued to develop a model duty statement and select core competencies. The draft model duty statement
for the TB Public Health Nurse Consultant was used as a template, as there were no competencies identified
related to the collaboration between corrections and public health. These competencies define the range of
core functions or duties for the Corrections Liaison with associated activities and then provide references for
the practice.
The selected template for core competencies for the Corrections TB Liaison are drawn from the Public Health
Nursing Competencies by the Quad Council of Public Health Nursing Organizations, found at
http://www.achne.org/files/Quad%20Council/QuadCouncilCompetenciesforPublicHealthNurses.pdf and
became the template for the corrections competencies.
Based on the Core Competencies for Public Health Professionals by the Council on Linkages between
Academia and Public Health Practice, found at
http://www.phf.org/resourcestools/Documents/Core_Competencies_for_Public_Health_Professionals_2014Jun
e.pdf and the Scope and Practice of Nursing in Correctional Facilities, American Nurses Association these
competencies represent the knowledge, skills, and abilities needed for the practice of assisting public health to
work with corrections in the control of tuberculosis in correctional facilities.
NTCA/NTNC Workgroups for Public Health Workforce Development in TB Programs:
Model Duty Statement and Core Competencies: Public Health TB Program Corrections Liaison
Updated September 2015
Page 1
Corrections Liaisons who are not clinicians still possess certain knowledge about the diagnosis, treatment and
management of latent tuberculosis infection (LTBI) and TB. Liaisons support TB programs and act to bridge
the gap between correctional facility staff and the TB program staff.
Timely communications between correctional and detention facilities, law enforcement agencies, and public
health agencies are imperative. In particular, Corrections Liaisons should consult the appropriate public health
and/or medical official in instances when TB is suspected or diagnosed, inmates are isolated in an airborne
infection isolation room , an inmate is co-infected with HIV, has drug-resistant TB, exhibits possible adverse
effects from anti-tuberculosis medications, is medically complicated for any reason, does not show clinical
improvement with treatment, has interruption of treatment, is pending release, or if there is possible TB
transmission in the facility or to the community.
The following Model Duty Statement and competencies reflect the vision of this core group and other
professionals, including those working in correctional and detention facilities, law enforcement agencies, and
local and state health departments. These competencies reflect current recommendations from CDC,
published in in 2006, Prevention and Control of Tuberculosis in Correctional and Detention Facilities.
This document should serve as a guide to the responsibilities and competencies for Corrections Liaisons
involving best practices. The goals outlined in this document require collaborations between staff at public
health departments and in correctional facilities. This document has been assembled with the understanding
that not all programs will be able to complete all of the goals that are outlined, but rather to provide a
comprehensive list of knowledge, skills, abilities, competencies, and functions that are commonly attributed to
Corrections Liaisons.
Model Duty Statement: TB Corrections Liaison
The public health TB Corrections Liaison assists with the following with regard to the corrections and detention
setting
1. TB technical expertise
2. Knowledge of procedures
3. Oversight and consultation
4. Policies and standards that support TB control
5. Contact investigations
6. Communication related to surveillance data and epidemiologic profiles
7. Training and education
8. Program evaluation
9. Collaboration with partners
10. Release planning
Job titles include (but are not limited to):
1.
2.
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5.
6.
7.
Public Health Nurse/Consultant
TB Coordinator
Program Specialist
Public Health Advisor
Training and Education Specialist
Communicable Disease Investigator
TB Controller – especially in low incidence states with fewer human resources in the TB program
NTCA/NTNC Workgroups for Public Health Workforce Development in TB Programs:
Model Duty Statement and Core Competencies: Public Health TB Program Corrections Liaison
Updated September 2015
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Goals for these competencies include:
1. Identify TB program functions for the Corrections Liaison to provide appropriate expert services to
correctional facilities.
2. Facilitate cross training between correctional and detention facilities and public health agencies with
regard to TB control.
3. Recognize differences and challenges of collaboration between correctional and detention facilities, law
enforcement agencies, public health agencies, and the community at large and facilitate bridging the
gaps.
4. Understand the organizational relationships that operate within the detention facilities
Note: For the purpose of this document, corrections or corrections staff refers to both custodial and medical
staff working in correctional facilities unless otherwise specified.
NTCA/NTNC Workgroups for Public Health Workforce Development in TB Programs:
Model Duty Statement and Core Competencies: Public Health TB Program Corrections Liaison
Updated September 2015
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The public health TB Program Corrections Liaison assists with the
following corrections-specific domains
Domain #1: Tuberculosis (TB) Technical Expertise in CORRECTIONS
The TB Program Corrections Liaison demonstrates and discusses knowledge of
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Epidemiology of TB Disease and Latent TB Infection (LTBI)
o Groups at high-risk for TB exposure and TB disease
o Risk factors for LTBI and TB disease
o Regions around the world with a high incidence of TB
 TB Diagnosis
o Diagnostic tests for infection with Mycobacterium tuberculosis and interpretation of test
results
o The indications, advantages, and limitations of tests that are used for the diagnosis and
management of TB such as:
 The tuberculin skin test (TST) and interferon-gamma release assay (IGRA)
 Chest radiography
 Sputum collection and/or induction
 Nucleic acid amplification tests (NAAT) including GeneXpert®
 Mycobacteriology services for acid fast bacilli (AFB) smear, culture, and drug
susceptibility testing
 Genotyping analysis
 HIV test
TB Management, Treatment, and Side Effects
o Public health goals of TB patient management including promptly initiating treatment,
completing effective therapy, reducing transmission, and preventing development of drugresistant TB
o Criteria for discontinuing airborne infection isolation and housing patients in general
detention population
o The clinical presentation and management of the TB patient
o Priority candidates for treatment of LTBI
o Treatment regimens for TB disease and LTBI
o Medication supervision by directly observed therapy (DOT)
o Case management for all cases of TB and LTBI within corrections
o The clinical management needs of the inmate with HIV/TB co-infection
o Management strategies for the inmate with multidrug-resistant (MDR) TB and extensively
drug-resistant (XDR) TB Explains toxicities and medication interactions for each of the
medications
 TB Prevention and Control
o Administrative controls
o Transmission factors
o Environmental TB control measures (e.g., airborne infection isolation rooms, ventilation,
ultraviolet germicidal irradiation)
o Corrections systems and processes for controlling TB
o Public health systems and processes for controlling TB
 Contact Investigations
NTCA/NTNC Workgroups for Public Health Workforce Development in TB Programs:
Model Duty Statement and Core Competencies: Public Health TB Program Corrections Liaison
Updated September 2015
Page 4
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The principles of contact investigation, with specific expertise in applying that knowledge to
correctional and detention facilities
Guides and assists with contact investigations
Promotes clinical evaluations and treatment to infected contacts
Release Planning
o The transfer of patient’s treatment and care from one corrections setting to another to
ensure completion of treatment within a designated period
o Release planning for persons leaving correctional facilities and the importance of continuity
of care
Domain #2: Knowledge of Correctional Procedures
The TB program Corrections Liaison
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Discusses the differences in correctional facilities and law enforcement agencies and each
entity’s role in public health
Maintains ongoing relationships with correctional facilities within their jurisdiction
Maintains an understanding of epidemiology of the local corrections population
Demonstrates knowledge of procedures for inmate’s movement from facility to facility with
regard to
o Intake processes
o Inter-facility movement
o Intra-facility movement
o Inter-agency transfers
o Release from custody
Demonstrates an understanding of procedures for transferring inmates from the custody of
one law enforcement agency to another
Demonstrates knowledge of agency classification [e.g., Immigration and Customs
Enforcement (ICE), United States Marshal Service (USMS), state Department of Corrections
(DOC)]
Demonstrates knowledge of release procedures related to planning for corrections
Demonstrates understanding of the organizational relationships within correctional and
detention facilities in its jurisdiction
Domain #3: Oversight and Consultation
The TB Program Corrections Liaison
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Demonstrates knowledge of TB disease and LTBI, and applies this knowledge as appropriate
Recognizes drug safety issues and fosters adherence to and completion of recommended
treatment
Helps facilitate release planning to an appropriate facility, community or residence
Conveys the importance of removing individual treatment barriers regarding behavior patterns,
cultural beliefs and values, or concurrent psychosocial issues (e.g., substance abuse, mental
health disorders), and recommends strategies in conjunction with the local TB program
Maintains information on TB cases in corrections to ensure that providers
o Facilitate the use of appropriate and effective drugs
NTCA/NTNC Workgroups for Public Health Workforce Development in TB Programs:
Model Duty Statement and Core Competencies: Public Health TB Program Corrections Liaison
Updated September 2015
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Intervene when treatment is not consistent with CDC/ATS/IDSA recommendations
Identify and address treatment barriers
Provides consultation or assistance to identify, locate, and evaluate high and medium priority
contacts, both inside and out of the correctional facility
Coordinates with correctional partners on all aspects of contact investigations
Assists corrections providers in TB prevention and control measures as outlined in Domain #1
Educates corrections and health service staff on
o Training for the proper application, reading, and interpretation of tuberculin skin tests,
o How to apply federal and state laws, regulations, and procedures to protect the public’s
health and ensure the individual’s rights,
o Conducting annual TB risk assessments,
o When to implement civil detention or court orders of non-adherent TB patients, and
o Use of community and public health resources for release planning
Promotes the use of evidence-based interventions in working with correctional medical staff
regarding TB disease
Facilitates the use of community and public health resources for release planning
Domain #4: Policies and Standards that Support TB Control
The TB Program Corrections Liaison
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Supports federal, state and local correctional policy aimed at reducing risk factors for TB
transmission within the facility, for staff and inmates
Provides leadership in developing policies that support TB control and prevention activities
within the facility
Assists with development and review of policies and standards relevant to TB and LTBI, and
all aspects thereof within the correctional facility
Assists with writing, summarizing and presenting clear and concise policy statements
Assists with articulating the health, administrative, legal, social, and political implications of
policies within the facility
States the feasibility and expected outcomes of each policy option
Serves as a resource for the development and review of plans and policies
Assists with development of mechanisms for monitoring and evaluating activities for
effectiveness and quality within the facility
Uses evidence-based findings in assisting with the development and/or change of TB health
policies, explaining the advantages and disadvantages of each option
Domain #5: Communication Related to Surveillance Data and Epidemiologic Profiles
The TB Program Corrections Liaison
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Possesses knowledge of available data sources
Identifies the purpose, procedure, and reporting mechanisms for required TB data reporting
systems
Instructs correctional facility staff and inmates regarding the importance of follow-up of TB
treatment using available data
Establishes frequency of data collection and analysis by health department
NTCA/NTNC Workgroups for Public Health Workforce Development in TB Programs:
Model Duty Statement and Core Competencies: Public Health TB Program Corrections Liaison
Updated September 2015
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Works with facility staff and other agencies to gather data related to inmates and staff for
epidemiology purposes (e.g., TB disease, persons with suspected TB, LTBI, TST or IGRA
conversions, particularly within the context of contact investigations)
Ensures the analysis of TB data gathered related to inmates and staff for epidemiology
purposes
Ensures the need for a source investigation when data indicate
Develops written reports in collaboration with key staff
Ensures timely case reporting is accomplished
Ensures additional TB data are reported to the appropriate department of health
Communicates results in written and oral presentations
Follows up on reports to appropriate agencies to ensure the accuracy and usefulness of
information
Uses reports to determine need for additional data collection, analysis, and interpretation
Domain #6: Training and Education
The TB Program Corrections Liaison
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Maintains current knowledge of available education and training resources and adapts
information for use within the context of state, local and facility guidelines
Describes educational activities within the context of the public health and corrections TB
program goals and objectives
Conducts assessments to determine TB education and/or training needs of the health care
staff, facility staff and inmates
Defines gaps in available resources and identifies needs of health care providers, staff and
inmates.
Recognizes and addresses misconceptions about TB
Facilitates training and education activities, including but not limited to development of health
education materials
Communicates changes in clinical practice recommendations to corrections staff as
appropriate
Initiates and/or develops indicators and methods for monitoring and evaluating TB education
and training activities for effectiveness and quality
Informs and educates decision makers regarding the needs of corrections, public health, the
individual TB patient, and the safe practice of nursing and infection control
Advocates for TB control in the correctional setting through participation in clinical,
epidemiological, and operational research using knowledge of public health and corrections
Domain #7: Program Evaluation
The TB Program Corrections Liaison
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Demonstrates knowledge of program evaluation through:
o Process (or implementation) evaluation;
o Outcome evaluation;
o Impact evaluation; and
Serves as a resource for correctional and detention facilities for
o Understanding TB-related outcomes
NTCA/NTNC Workgroups for Public Health Workforce Development in TB Programs:
Model Duty Statement and Core Competencies: Public Health TB Program Corrections Liaison
Updated September 2015
Page 7
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Developing outcome-oriented objectives
Conformance to
 Statutory and regulatory requirements
 Program design
 Professional standards
 Measuring outcomes to evaluate the corrections TB program effectiveness (to include
unintended effects)
 Interpretation of outcomes data
Domain #8: Collaboration with Partners
The TB Program Corrections Liaison
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Identifies key partners in the federal, state and local public health and correctional facilities,
including law enforcement agencies and others as appropriate
Establishes and maintains relationships with key partners to better serve the needs of the
community and the correctional facility staff and inmates
Establishes methods of communication between local health agencies, correctional facility
staff and other key partners
Uses leadership, team building, communication, negotiation, and conflict resolution skills to
build partnerships with corrections staff
Works with key partners in corrections to effectively diagnose and treat TB in their facility
Applies knowledge of community resources offered by the key partners to better address the
social needs of the discharged/released inmates and correctional staff receiving treatment
from local providers
Works with key partners in creating or changing policies/procedures to address the needs of
inmates being discharged/released to the community
Assesses and provides education and training to key corrections medical staff for effective
diagnosis and treatment for persons with TB or LTBI
Assesses and provides corrections-specific education and training to key correctional staff in
identification of signs and symptoms of TB, case management, contact investigation
involvement, and all aspects of the corrections TB program
Encourages the partnership between corrections and local public health jurisdictions
Domain #9: Release Planning
The TB Program Corrections Liaison
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Establishes and maintains open dialogue with key stakeholders
Identifies correctional and/or community assets and available resources as patient transitions
from one health jurisdiction to another or from one law enforcement agency to another
Selects and defines areas necessary to ensure continuity of care
Collaborates with partners (private providers and other entities, such as federal, state and
local law enforcement agencies) to promote the health of the population by ensuring the
continuity of care as patients
o transfer or relocate to other correctional facilities
o transfer to the custody of other law enforcement agencies
o are released to the community
NTCA/NTNC Workgroups for Public Health Workforce Development in TB Programs:
Model Duty Statement and Core Competencies: Public Health TB Program Corrections Liaison
Updated September 2015
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are repatriated to their country of nationality or other receiving country
Determines priority for follow-up and the appropriate course of action
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Identifies relevant, appropriate data and information sources to provide a complete patient
history and referral
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Assists with arranging for confidential transfer of key clinical records
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Uses community networks to communicate information
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Educates correctional and detention facility staff on the importance of maintaining
confidentiality of medical information and legally permissible use (i.e., can share with public
health agencies without the inmates’ written consent)
NTCA/NTNC Workgroups for Public Health Workforce Development in TB Programs:
Model Duty Statement and Core Competencies: Public Health TB Program Corrections Liaison
Updated September 2015
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Contributors
2004:
Ellen Murray, RN, BSN, Southeastern National TB Center, Chair; Phil Griffin, Kansas State
TB Controller, Kathy Kolaski, RN, MSN, Georgia Dept. of Health; Chris Hayden, NJ RTMCC; Joni
Clafin, RN, Oklahoma Dept. of Corrections; Diana Fortune, RN, Missouri Dept. of Health; Graham
Briggs, Corrections Liaison, Arizona Dept. of Health; Lorena Jeske, RN, Washington Dept. of Health.
2008:
Mark Lobato, MD, CDC, DTBE; Sandra Morris, Texas Dept. of Health, Diana Schneider,
DrPH, Division of Immigration and Health Services, Washington, DC; Josie Ford, RN, Massachusetts
Dept. of Health; Sevim Ahmedov, Florida Dept. of Health; Debra Spike, RN Consultant, Florida Dept.
of Health; Jennifer Jones, RN, Division of Immigration and Health Services, Washington, DC; Farah
Parvez, MD, MPH, CDC, New York City, NY; Dorothy Murphy, RN, Cook County Jail, Chicago,
Illinois; Sum Brun, RN, Kansas Dept. of Corrections; Jackie Standridge, RN, Kansas Dept. of
Corrections; Lauris Harley, Virgin Islands Dept. of Health; and Rachel Purcell, Florida Dept. of Health.
Ellen Murray, BSN, RN, Southeastern National TB Center (chair).
2015:
Mark Lobato, MD, CDC, DTBE, Ellen Murray, RN, BSN, Southeastern National TB Center,
Lauren Lambert, MPH, CDC, DTBE, Carol Greene, California Dept. of Public Health, Maria Galvis,
CDC, DTBE, Rose Bramble, RN, BSN, New Mexico Dept. of Health, Ben Katz, MPH, Tennessee
Department of Health, Sherrie Arnwine, RN, Florida Dept. of Health, Diana Elson, DrPH, MA, ICE
Health Service Corps.
NTCA/NTNC Workgroups for Public Health Workforce Development in TB Programs:
Model Duty Statement and Core Competencies: Public Health TB Program Corrections Liaison
Updated September 2015
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Updated September 2015
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Model Duty Statement and Core Competencies: Public Health TB Program Corrections Liaison
Updated September 2015
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http://www.vdh.virginia.gov/TB/guidebook/documents/2001gdbk.pdf.
Washington State Department of Health. TB Program. IX High Risk Populations: Cure TB
brochure.
NTCA/NTNC Workgroups for Public Health Workforce Development in TB Programs:
Model Duty Statement and Core Competencies: Public Health TB Program Corrections Liaison
Updated September 2015
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